Conventional surgical procedures for pathologies and/or trauma located deep within the body can cause significant trauma to intervening tissues. Open surgical procedures often require a long incision, extensive muscle stripping, prolonged retraction of tissues, denervation, and devascularization of tissue in order to access a surgical site. Most of these surgeries require several hours of recovery room time and several weeks of post-operative recovery time due to the use of general anesthesia and the destruction of tissue during the surgical procedure. In some cases, these invasive procedures lead to permanent scarring and pain.
Minimally invasive alternatives, such as endoscopic techniques, reduce pain, post-operative recovery time, and the destruction of healthy tissue. In minimally invasive surgery, the site of pathology is accessed through portals rather than through a significant incision, thus preserving the integrity of intervening tissues. These minimally invasive techniques also often require only local anesthesia. The avoidance of general anesthesia can reduce post-operative recovery time and the risk of complications.
Nevertheless, there still exists a need for the development of devices and methods to improve minimally invasive surgical techniques. For example, some endoscopic procedures, such as peroral cholangioscopy, suffer procedural inefficiency due to limitations in currently available medical devices. Peroral cholangioscopy is usually performed by two experienced endoscopists using a “mother-baby” scope system, in which a thin fiberscope is inserted into the working channel of a large therapeutic endoscope (e.g., a duodenoscope). The mother-baby scope technique can be expensive with regard to personnel and equipment: two endoscopists plus assistants, two image processors (one for each camera), and expensive fiber optics in the baby scope that can often be damaged during standard manipulation with resulting image degradation. The standard 1.2 mm working channel of fiber optic baby scopes limits diagnostic and therapeutic options. It is therefore desirable to provide an endoscope configured to function as a cholangioscope by being dimensioned to be navigable through hepatic and pancreatic ducts. Such scopes are currently available, but they encounter problems of efficient introduction to a patient's biliary duct in a procedure that provides high quality images (e.g., superior to fiber optics imaging) at a desirable procedure cost. These problems include the difficulty of navigating a larger fiber optic baby scope having a greater than 1.2 mm working channel through a mother scope and into a patient's biliary duct. If one is to introduce a small scope (along the size of a “baby scope” or smaller) into the biliary ducts or other patient body structure without a primary (e.g., “mother”) scope, it is necessary to provide some type of “navigating track” because the smaller scopes are not sufficiently rigid/robust to be directed/navigated independently and directly through the esophagus, stomach, and duodenum to, for example, the common bile duct.
Accordingly, techniques are being developed to conduct direct peroral cholangioscopy (POC). Direct POC requires only a single endoscopist working with a single image processor, using a CMOS or CCD camera system that provides a 2 mm accessory channel, and that can be used with existing scopes, image processors, and monitors. One example of such improved technology is disclosed in “Overtube-balloon-assisted direct peroral cholangioscopy by using an ultra-slim upper endoscope” (Choi et al., Gastrointestinal Endoscopy, 69(4):935-40, April 2009), where an over-tube with a balloon of the type used for double-balloon enteroscopy was directed into the duodenum adjacent the Ampulla of Vater with an ultra-slim scope supported in the lumen of the over-tube, whereafter the scope was directed into the previously-dilated bile duct.
It would be advantageous to provide devices for more efficient minimally invasive procedures. In particular, it would be advantageous to provide devices for efficient introduction of an ultra-slim scope suitable for cholangioscopy and pancreatoscopy in conjunction with use of a standard-sized endoscope (e.g., duodenscope) that can be exchanged out without significant loss of procedural efficiency, but without limiting the equipment and/or procedure to a mother-baby scope configuration, and also providing for easier, more efficient navigation into the bile duct or other locations.